Iranian Journal of Medical Physics

Iranian Journal of Medical Physics

Stereotactic Body Radiotherapy for Lung Lesions using Multiple Phase 3D-CT Based on the Analysis of Radiobiological Parameters

Document Type : Original Paper

Authors
Arun Chairmadurai 1
Harish Chandra Goel 2
Sandeep Kumar Jain 1
Pawan Kumar 1
1 Department Of Radiation Oncology, Jaypee Hospital, Sector-128, Noida-201304, U.P. India
2 Amity Centre for Radiation Biology, Amity University, Noida-201304, U.P. India
10.22038/ijmp.2018.35064.1438
Abstract
Introduction: Planning target volume (PTV) is generated from internal treatment volume (ITV) using four-dimensional computed tomography (4D-CT) for enhanced therapeutic gain in the stereotactic body radiotherapy for lung lesions (SBRT-Lung). This study aimed to propose a strategy to generate ITV on multiple-phase 3D-CT and enhance therapeutic gain in SBRT-Lung.
Material and Methods: This study was conducted on 6 peripherally located and 5 centrally located lung lesions suitable for SBRT. The PTV was delineated based on 3D-CT datasets acquired at three different phases of respiratory motion. The prescribed dose of 50 Gy in 5 fractions was delivered using RapidArc technique. The therapeutic-gain was compared based on tumor control probability (TCP) and normal tissue complication probability (NTCP) against a multicenter trial, which uses single-phase 3D-CT for PTV delineation. The TCP and NTCP were calculated by Poisson’s linear-quadratic and Lyman-Kutcher-Burman models, respectively.
Results: Regarding the multicentre trial, the PTVs were maximally reduced to 42% and 57% among the 6 peripherally and 5 centrally located lung lesions, respectively. In peripheral lung lesions, TCP was significantly enhanced to 0.6% for long-term (>5years) local control (p <0.05), and NTCP was significantly reduced in pneumonitis (Grade≥II) of lung (0.2%; p <0.05). In central lung lesions, TCP was insignificantly enhanced; however, NTCPs were maximally reduced for cartilage necrosis in trachea (35%) and myelitis in spinal cord (19%).
Conclusion: The proposed strategy reduced the complications for normal tissues and enhanced therapeutic gain. The successful clinical outcomes validated our hypothesis in short-term (6-12 months), and we are currently testing the long-term efficacy.
Keywords
SBRT-Lung
Radiobiology
Volumetric-Modulated Arc Therapy
Subjects

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Iranian Journal of Medical Physics
Volume 16, Issue 4 - Serial Number 4
July and August 2019
Pages 270-279

  • Receive Date 24 September 2018
  • Revise Date 29 October 2018
  • Accept Date 01 December 2018